Introduction: Osteoarthritis is a degenerative disease characterized by joint pain in the cartilage. It requires further management, especially in severe conditions that have not responded to pharmacological therapy, such as Total Knee Arthroplasty (TKA). Therefore, the authors aim to compare the knee quality of patients with Knee Society Scores (KSS) before and after TKA surgery.

Case description: Female patient, 55 years old, came with the chief complaint of stiffness and pain in both knees for the last two years. The patient had previously undergone regular treatment and is now getting worse. The radiological found the impression of right and left knee osteoarthritis was grade IV, and the KSS assessment results were 40. The patient was then treated with TKA surgery. After the total knee arthroplasty procedure was observed for one month, the patient had no complaints of joint stiffness and did not feel severe pain in both knees. The KSS assessment results were 71 with good interpretation results.

Conclusion: There was an improvement in the knee quality of patients with KSS before and after TKA surgery.

Background: Hyperglycemic hyperosmolar state (HHS) is a life-threatening rare acute complication of diabetes mellitus (DM). The condition should be distinguished from diabetic ketoacidosis (DKA) as the management differs significantly. HHS is classically associated with type 2 DM, but it has been increasingly reported in type I DM as well. The literature regarding HHS in children is still sparse. The management of HHS in children is extrapolated from the adult study.

Cases: The first case was male 5 years old, and the second case was female 15 years old. Both cases were typed 1 DM patient. The first case was newly diagnosed. Both of the patients came with general weakness, mild dehydration, overly high blood sugar, normal blood pH, hypocalcemia, glucosuria and only mild ketonuria. In the second case develop, both patients were rehydrated, given insulin and discharged in 7-10 days without any sequelae.

Conclusion: These case series emphasize the importance of recognizing HHS and differ it from DKA. These two cases prove that HHS is increasingly reported in children with clinical symptoms resembling DKA. It is also proven that with early diagnosis and correct management, children with HHS can be discharged home without any sequelae.

Introduction: Anal fissure is shallow tear in the anoderm distal to dentate line which is considered most common proctologic condition.  Anal fissure is generally located in the posterior midline. The symptoms include anal pain, spasm, and/or bleeding during defecation¹. The pain can be so intense as to induce the patient to avoid defecation with consequent hardening of the feces and exacerbation of the problem². Management of the anal fissure is improving diet and defecation habit, medical therapy and surgical therapy. The goal of medical treatment for chronic anal fissure is to temporarily reduce pressure of the anal canal to facilitate the healing of the fissure (“reversible sphincterotomy”), thereby reducing muscle tone. Intrasphincteric Botulinum Toxin A injection seems to be a reliable option.

Case reports: two male patients were diagnosed with anal fissures, the patients complained of pain and spasm. They were treated with  botulinum toxin type A (100 unit AllergenÒ), injected  into three sites of the internal sphincter at 2, 5 and 8 o’clock. The symptoms relieved and the anal fissure healed within one month. There was no sign of relapse or incontinence during 12 months of follow-up.

Conclusion: Botulinum toxin therapy can be considered as efficacious, effective and safe treatment for anal fissures.

Keywords: anal fissure, botox, botulinum toxin, intrasphincteric

Background: Keloids are nodular tumors with a soft and spongy consistency and have a shiny and soft surface. Lesions are absent in hair follicles and adnexal glands. The main mediators include transforming growth factor-beta (TGF-β), interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor (TNF), and vascular growth factor (VEGF). This case discusses the combination therapy of electrosurgery and frozen surgery in treating keloids.

Case description: A woman, 34 years old, Indonesian, has complained of a lump on her left shoulder since ten years ago, which has been getting harder and harder, sometimes accompanied by pain and itching. There was a solitary hyperpigmented nodule in the left deltoid region with firm boundaries, geographic shape, measuring 5.7 cm x 4 cm x 0.8 cm, regular edges, and a smooth and shiny surface. On palpation, the consistency is firm and firm. Dermoscopy showed multiple erythema nodules with vascular structures in the form of arborizing vessels and linear irregular vessels. Electrocauter surgery was performed with cut mode and continued with cryo surgery and the antibiotic ointment gentamicin 0.1% topically every 12 hours on lesions that have undergone electrosurgery, frozen surgery, and paracetamol tablets 500 mg every 8 hours intraorally if pain. On the 36th day of observation, clinical improvement of the lesions was found.

Conclusion: Cryo surgery is minimally invasive and can be combined with electrocautery surgery to reduce bleeding. The lesion improvement was seen after the combination treatment was given, although there were still hypertrophic scar lesions.

Latar belakang: Keloid merupakan tumor nodular dengan konsistensi lunak dan kenyal, memiliki permukaan berkilauan dan lunak. Lesi tidak terdapat pada folikel rambut dan kelenjar adneksal. Mediator utama meliputi transforming growth factor beta (TGF-β), interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor (TNF), dan vascular growth factor (VEGF). Kasus ini membahas terapi kombinasi bedah listrik dan bedah beku pada penanganan keloid.

Kasus: Wanita, 34 tahun, warga negara Indonesia, mengeluh adanya benjolan pada bahu kiri sejak 10 tahun yang lalu yang semakin lama semakin keras, terkadang disertai rasa nyeri dan gatal. Pada regio deltoid sinistra didapatkan adanya nodul hiperpigmentasi soliter batas tegas, bentuk geografika, berukuran 5,7 cm x 4 cm x 0,8 cm, tepi reguler, permukaan halus dan mengkilat. Pada palpasi didapatkan konsistensi padat kenyal dan terfiksir. Dermoskopi didapatkan gambaran nodul eritema multipel dengan struktur vaskular berupa arborizing vessels dan linear irregular vessels. Dilakukan tindakan bedah listrik dengan mode cut dan dilanjutkan dengan bedah beku serta salep antibiotik gentamisin 0,1% tiap 12 jam secara topikal pada lesi yang telah dilakukan bedah listrik dan bedah beku dan parasetamol tablet 500 mg tiap 8 jam intraoral bila nyeri. Pengamatan hari ke 36 didapatkan perbaikan klinis lesi.

Simpulan: Bedah beku merupakan tindakan invasif minimal dan dapat dikombinasikan dengan bedah listrik untuk mengurangi perdarahan selama tidakan dilakukan. Perbaikan lesi telihat setelah diberikan tindakan kombinasi walaupun masih terdapat lesi skar hiperterofik.

Background: Cellulitis is a skin infection involving the deep dermis and subcutaneous tissue, characterized by localized pain, swelling, tenderness, erythema, and warmth. The most common causes of cellulitis are group A streptococci and Staphylococcus aureus. Streptococcus agalactiae or the so-called group B Streptococcus can also cause cellulitis. This case report aims to evaluate the colonization of Citrobacter koseri and Streptococcus agalactiae in a case of cellulitis cruris dextra et sinistra.

Case Presentation: A 53-year-old married woman presented to the outpatient clinic complaining of swelling and redness in her left and right legs since five days ago. At first, there was only a little redness around the calf, but it became wider and pain in that area. On examination, there were multiple erythematous macules, patches, and multiple erosional lesions, warm palpable and tender to palpation, and the diascopy test disappeared with pressure. Based on the wound culture results, isolated Citrobacter koseri and Streptococcus agalactiae bacteria were considered colonization. Both of these bacteria were less virulent. The patient was treated with systemic and topical antibiotics, analgesics, wound care management and elevated lower limbs.

Conclusion: The diagnosis of cellulitis is based on history and physical examination. On examination of the wound culture of this case, Citrobacter koseri and Streptococcus agalactiae were found, considered as colonization. The patient showed clinical improvement at each observation after administration of antibiotics and wound care management. The patient's prognosis is dubious ad bonam.

Background: Lumbar spinal stenosis (LSS) is the most common subtype of spinal stenosis. This pathologic disorder is the most common cause of low back pain in elderly. LSS can be either congenital or acquired, which the disorder is mainly caused by the degenerative process. Diagnosis of LSS is made by combination of clinical manifestations and radiological findings. Management of LSS may include conservative measures in form of physical therapy, steroid injection on facet joints or epidural space, and also surgical decompression procedure. LSS often reduces invididuals’ quality of life and productivity; hence, it is the most common indication for lumbar spinal canal decompression procedure.

Case report: A 41 years old woman complained of low back pain that was referred to the left buttock and leg area. The complaints were also accompanied by numbing sensation on the antero-lateral side of the left leg. Complaints have been felt continuously since 5 months ago. From physical examination, the Visual Analogue Scale (VAS) was 5-6 with positive laseque test on left leg accompanied with hypoesthesia in L4, L5, and S1 dermatome. MRI findings suggested the diagnosis of canalis stenosis of L4-L5 and L5-S1. We perfomed laminectomy and Posterior Lumbar Interbody Fusion (PLIF) on this patient.

Conclusion: Surgical approaches are based on the anatomic location, number of segment affected, involvement of thoracolumbar junction, transitional anatomy, instability, and deformity. Factors that affect patients’ clinical outcome after the surgical procedure should be considered before starting the procedure.

Latar belakang: Lumbar spinal stenosis (LSS) merupakan jenis stenosis spinal yang paling sering dijumpai, dimana kelainan ini merupakan salah satu penyebab patologis tersering dari nyeri punggung bawah pada populasi lansia. LSS dapat berupa kelainan kongenital ataupun kelainan yang didapat, dimana kebanyakan LSS diakibatkan oleh proses degeneratif. Diagnosis LSS melibatkan kombinasi dari temuan klinis dan radiologis. Tatalaksana pasien LSS dapat meliputi upaya konservatif berupa terapi fisik, injeksi steroid pada persendian facet ataupun ruang epidural, hingga tindakan operasi dekompresi. LSS seringkali menurunkan kualitas hidup serta produktivitas seseorang, sehingga LSS sering dijadikan sebagai indikasi untuk dilakukan prosedur operasi medula spinalis lumbal.

Laporan kasus: Wanita, 41 tahun mengeluh nyeri punggung bawah serta nyeri yang menjalar ke bokong dan tungkai kiri, yang disertai sensasi kebas pada tungkai kiri sisi antero-lateral. Keluhan dirasakan terus menerus sejak 5 bulan lalu. Pemeriksaan fisik di dapatkan Visual Analogue Scale (VAS): 5-6, tes laseque positif tungkai kiri serta hipoestesia pada dermatom L4, L5 dan S1. Temuan MRI lumbal mengarah kepada diagnosis stenosis kanalis L4-L5 dan L5-S1. Dilakukan laminektomi dan Posterior Lumbar Interbody Fusion (PLIF).

Kesimpulan: Pemilihan modalitas bedah didasarkan pada lokasi anatomis, jumlah segmen, keterlibatan thoracolumbar junction, adanya anatomi transisional, instabilitas, ataupun deformitas. Beberapa faktor yang mempengaruhi luaran klinis pasien pasca prosedur operasi perlu menjadi pertimbangan sebelum memulai tindakan bedah.

Background: Community pneumonia referred to as community acquired pneumonia is pneumonia that is often found in the community and the leading cause of death for infectious diseases. This pneumonia requires therapy with antibiotics. One of the main problems in using antibiotics is the occurrence of antibiotic resistance. This study aims to determine the profile of antibiotic use in patients with community acquired pneumonia, which is commonly referred as acquired pneumonia in the community.

Methods: This study is a literature review that uses articles with a randomized controlled trial design and articles in Indonesian or English and has a publication year, namely the last 10 years. The keywords used were "Treatment" AND "Community acquaired pneumonia" AND "Antibiotic or Antimicrobial" AND "Mortality OR Clinical response OR Severity".

Results: The quality of journals in this study was assessed by means of a critical appraisal skills program checklist and journal reputation. The results obtained were 9 articles that met the inclusion and exclusion criteria. The antibiotic that is often used in outpatient community acquired pneumonia without comorbidities is nemonoxacin 500 mg and in non-severe hospitalized patients the commonly used antibiotic is beta-lactam monotherapy.

Conclusion: The conclusion in this study is that the antibiotic that is often used in outpatient CAP patients is Nemonoxacin 500 mg while inpatient CAP is beta-lactam monotherapy so that in both groups the use of antibiotics is not in accordance with the 2019 ATS guidelines therefore requires monitoring the use of antibiotics in patients with community acquired pneumonia.

Latar belakang: Pneumonia komunitas atau biasanya disebut dengan community acquired pneumonia yaitu pneumonia yang sering didapatkan di masyarakat dan merupakan penyebab kematian penyakit menular tertinggi. Pneumonia ini membutuhkan terapi dengan menggunakan antibiotik. Salah satu masalah utama dalam penggunaan antibiotik adalah terjadinya resistensi antibiotik. Penelitian ini bertujuan untuk mengetahui profil penggunaan antibiotik pada pasien community acquired pneumonia atau biasanya disebut dengan pneumonia yang didapatkan di komunitas.

Metode : Penelitian ini merupakan kajian literatur yang menggunakan artikel dengan desain randomized controlled trial dan artikel yang menggunakan bahasa Indonesia atau bahasa inggris dan memiliki tahun publikasi yaitu 10 tahun terakhir. Kata kunci yang digunakan adalah "Treatment" AND "Community acquaired pneumonia" AND “Antibiotic or Antimicrobial” AND “Mortality or Clinical response or Severity”.

Hasil : Kualitas jurnal pada penelitian ini dinilai dengan checklist critical appraisal skill program dan  reputasi jurnal. Hasil yang didapatkan adalah 9 artikel yang memenuhi kriteria inklusi dan ekslusi. Antibiotik yang sering digunakan pada pasien community acquired pneumonia rawat jalan tanpa komorbiditas adalah nemonoxacin 500 mg dan pada pasien rawat inap non severe antibiotik yang sering digunakan adalah monoterapi beta-laktam

Kesimpulan : pada penelitian ini adalah Antibiotik yang sering digunakan pada pasien CAP rawat jalan adalah Nemonoxacin 500 mg sedangkan pada  CAP  rawat inap  adalah monoterapi beta-laktam sehingga pada kedua kelompok tersebut penggunaan antibiotik tidak sesuai dengan guideline ATS tahun 2019 sehingga masih membutuhkan pengawan penggunaan antibiotik pada pasien community acquired pneumonia.

Background:  In supporting exist service, hospitals need competent employees and good performance of human resources in order to optimize organizational performance that implements the principles of good corporate governance. The purpose of this study was to analyze the effect of competence and performance of human resources in the application of the principles of good corporate governance at the Regional General Hospital of North Sulawesi Province.Method:  This type of research is analytic observational with a cross sectional study approach. This research was carried out at the Regional General Hospital of North Sulawesi Province in February 2022. The research sample was taken from existing employees with a simple random sampling technique with a total of 182 samples of respondents. The inclusion criteria in this study were ASN and THL who worked at the Regional General Hospital of North Sulawesi Province. The data in this study were taken through the distribution of questionnaires and filled out by employees as respondents. Data analysis used univariate, bivariate and multivariate tests using SPSS version 25 for Windows.

Result:  Respondents of ASN employees were 104 people (57,1%) and THL were 78 people (42,9%). chi square test shows that there is an influence between competence and performance of human resources in the application of good corporate governance principles (p value<0,000). The logistic regression test shows that competence has a positive effect on the application of the principles of good corporate governance with an odd ratio of 29,234 and the performance of human resources has a positive effect on the application of the principles of good corporate governance with an odd ratio of 10,792. Competence and performance of human resources simultaneously affect the application of the principles of good corporate governance seen from the calculated chi square value is greater than the chi square table (88,895>5,991).

Conclusion: Competence and performance of human resources partially have a positive effect on the application of good corporate governance principles to employees at the Regional General Hospital of North Sulawesi Province.

Latar Belakang: Dalam menunjang pelayanan yang ada, rumah sakit membutuhkan pegawai yang kompeten dan juga kinerja sumber daya manusia yang baik dalam rangka optimalisasi kinerja organisasi yang menjalankan prinsip good corporate governance. Tujuan penelitian ini untuk menganalisis pengaruh kompetensi dan kinerja sumber daya manusia dalam penerapan prinsip-prinsip good corporate governance di Rumah Sakit Umum Daerah Provinsi Sulawesi Utara

Metode: Jenis penelitian bersifat obsevasional analitik dengan pendekatan cross sectional study. Penelitian ini dilaksanakan di Rumah Sakit Umum Daerah Provinsi Sulawesi Utara pada bulan Februari 2022. Sampel penelitian diambil dari pegawai yang ada dengan teknik pengambilan sampel simple random sampling dengan jumlah responden sebanyak 182 sampel. Kriteria inklusi dalam penelitian ini adalah ASN dan THL yang bekerja di Rumah Sakit Umum Daerah Provinsi Sulawesi Utara. Data dalam penelitian ini diambil melalui pembagian kuesioner dan diisi oleh oleh pegawai sebagai responden. Analisis data menggunakan uji univariat, bivariat dan multivariat menggunakan SPSS versi 25 untuk WIndows.

Hasil: Responden pegawai ASN 104 orang (57,1%) dan THL sebanyak 78 orang (42,9%). Uji chi square menunjukkan adanya pengaruh antara kopetensi dan kinerja sumber daya manusia dalam penerapan prinsip-prinsip good corporate governance (nilai p<0,000). Uji regresi logsitik menunjukkan kompetensi berpengaruh positif terhadap penerapan prinsip-prinsip good corporate governance dengan odd ratio 29,234 dan kinerja sumber daya manusia berpengaruh positif dalam penerapan prinsip-prinsip good corporate governance dengan odd ratio 10,792. Kompetensi dan kinerja sumber daya manusia berpengaruh secara simultan dalam penerapan prinsip good corporate governance dilihat dari nilai chi square hitung lebih besar dari chi square tabel (88,895>5,991).

Kesimpulan: Kompetensi dan kinerja sumber daya manusia secara parsial berpengaruh positif dalam penerapan prinsip-prnsip good corporate governance pada pegawai di Rumah Sakit Umum Daerah Provinsi Sulawesi Utara.

Background: Self-directed learning (SDL) is a skill that must be possessed by medical students as a form of adult learning. To train these skills, students need tutors to stimulate students' SDL abilities.

Methodology: This study was conducted quantitatively using a Dolman and Ginns questionnaire on third-year medical students.

Results: Tutors in the Medical Emergency block were able to provide a good explanation of the issues in the case and stimulate students to look for other learning resources.

Conclusion: Tutors with academic backgrounds that match the discussion material can be considered as one of the factors that can stimulate students' SDL.

Latar Belakang: Self-directed learning (SDL) merupakan keterampilan yang harus dimiliki oleh mahasiswa kedokteran sebagai bentuk pembelajaran dewasa. Untuk melatih keterampilan ini mahasiswa memerlukan tutor dalam menstimulasi kemampuan SDL mahasiswa.

Metodologi: penelitian ini dilakukan secara kuantitatif dengan menggunakan kuisioner Dolman dan Ginns pada mahasiswa kedokteran tahun ke-tiga.

Hasil: tutor pada blok Medical Emergency mampu memberikan penjelasan yang baik mengenai issue yang ada pada kasus serta menstimulasi mahasiswa untuk mencari sumber pembelajaran yang lainnya.

Simpulan: tutor dengan latar belakang akademik yang sesuai dengan materi diskusi dapat dipertimbangan sebagai salah satu factor yang dapat menstimulasi SDL mahasiswa.

Background: Anthocyanins are flavonoids that have various potentials such as antioxidant, anti-inflammatory and antiapoptotic. One source of anthocyanins which is common among the Indonesian are purple sweet potato (Ipomoea batatas L.). Its potential can be used to prevent and treat the effects of substances including psychostimulants. Methylphenidate (MPH) is one of the psychostimulants used as therapeutic option for ADHD, but its use has several controversies, such as the occurrence of toxicity and long-term damage. This study aimed to examine the effect of purple sweet potato ethanol extract on levels of the striatum dopamine neurotransmitter and stereotypic behavior in methylphenidate-induced rats.

Method: This research is a randomized posttest–only control group. Samples were male Wistar rats (Rattus norvegicus), aged 6-8 weeks (randomly divided into 2 groups). The treatment group was given purple sweet potato ethanol extract before MPH injection. Examination of dopamine levels using ELISA and stereotyped behavior were assessed using the stereotyped behavior rating scale. Statistical test was by Mann Witney test and independent t-test.

Results: The results showed striatum dopamine levels were significantly lower in the treatment group (given purple sweet potato ethanol extract before MPH was induced) than the control (6.83±2.83 vs. 10.02±4.35; p<0.05). Stereotypic behavior in the treatment group was significantly lower than the control group (3.46±0.63 vs. 3.96±0.70; p<0.05).

Conclusion: The ethanolic extract of purple sweet potato is thought to have antidopaminergic potential and cause a decrease in stereotypic behavior in MPH-induced wistar rats.

Latar belakang: Antosianin merupakan flavonoid yang memiliki berbagai potensi seperti antioksidan, antiinflamasi dan antiapoptosis. Salah satu sumber antosianin yang mudah ditemukan dan cukup umum di kalangan penduduk lokal Indonesia adalah ubi jalar ungu (Ipomoea batatas L.). Potensinya dapat mencegah dan mengobati dampak yang ditimbulkan oleh zat psikostimulan. Methylphenidate (MPH) merupakan salah satu psikostimulan yang digunakan sebagai pilihan terapi untuk Attention-deficit hyperactivity disorder (ADHD), namun pemakaiannya memiliki beberapa kontroversi seperti terjadinya efek toksik, penyalahgunaan dan timbulnya kerusakan jangka panjang. Penelitian ini bertujuan untuk melihat pengaruh pemberian ekstrak etanol ubi jalar ungu terhadap kadar neurotransmiter dopamin striatum dan perilaku stereotipi pada tikus yang diinduksi methylphenidate.

Metode: Rancangan penelitian yang digunakan yaitu randomized posttest–only control group. Sampel penelitian adalah tikus (Rattus norvegicus) galur Wistar jantan, berumur 6-8 minggu (secara random dibagi dalam 2 kelompok). Kelompok perlakuan diberikan ekstrak etanol ubi jalar ungu sebelum diinjeksi MPH, sedangkan kelompok kontrol tidak. Pemeriksaan kadar dopamin menggunakan teknik Elisa dan perilaku stereotipi dinilai memakai stereotyped behavior rating scale. Uji statistik menggunakan uji mann witney dan independent t-test.

Hasil: Hasil penelitian menunjukkan kadar dopamin striatum lebih rendah secara bermakna pada kelompok perlakuan (diberikan ekstrak etanol ubi jalar ungu sebelum diinduksi MPH) dibandingkan kontrol (6,83±2,83 vs. 10,02±4,35; p<0,05). Perilaku stereotipi pada kelompok perlakuan lebih rendah secara signifikan dibandingkan kontrol (3,46±0,63 vs. 3,96±0,70; p<0,05).

Kesimpulan: Ekstrak etanol ubi jalar ungu diperkirakan memiliki potensi antidopaminergik dan menyebabkan penurunan perilaku stereotipi pada tikus wistar yang diinduksi MPH.

Introduction: Callus and clavus are skin disorders in the form of hyperkeratotic lesions that are common and can affect the patient's quality of life. Callus and clavus can occur in men or women of all ages. Treatment of callus and clavus has a low cost benefit but has received little attention and until now there is no gold standard of treatment that is considered ideal. Data on callus and clavus characteristics, common treatments, and the final outcome of callus and clavus therapy have not been widely reported so that it has an impact on the standard management of these two lesions. The aim of this study was to evaluate the description of callus and clavus cases in the form of gender, age, location lesions, management, and cure rate 1 month after therapy in the Outpatient Unit (URJ) Skin and Venereology Tumor Division and Skin Surgery (TBK) Regional General Hospital (RSUD) Dr. Soetomo, Surabaya.

Methods: A cross-sectional retrospective descriptive study on 25 Electronic Medical Records (EMR) patients with callus and clavus who met the inclusion and exclusion criteria at the Dermatology and Venereology Outpatient Unit, Skin Surgery Tumor Division (TBK) RSUD Dr. Soetomo Surabaya period January 2016 - December 2020.

Results: Twenty-five samples were recruited in this study consisting of 13 (52%) male patients and 12 (48%) female patients. Clavus dominated all cases in 20 (80%) cases, while callus was in 5 (20%) cases. The lower extremity was the most common site for lesions in 20 (80%) cases. Excision was the most frequently chosen method in 21 (84%) cases. Clinical recovery after 1 month after therapy was obtained in 20 (80%) cases.

Conclusion: Management of callus and clavus in URJ Skin and Venereology, TBK Division, RSUD Dr. Soetomo, Surabaya showed a cure rate of 80% with the most preferred modality being excision.

Pendahuluan: Kalus dan klavus adalah kelainan kulit berupa lesi hiperkeratotik yang umum didapatkan dan dapat mempengaruhi kualitas hidup pasien. Kalus dan klavus dapat terjadi pada pria ataupun wanita di segala rentang usia. Tatalaksana kalus dan klavus memiliki cost benefit yang rendah namun kurang mendapat perhatian dan hingga saat ini belum terdapat standar emas tatalaksana yang dianggap ideal. Data karakteristik kalus dan klavus, tatalaksana yang umum dilakukan, dan hasil akhir dari terapi kalus dan klavus belum banyak dilaporkan sehingga berdampak pada standar manajemen kedua lesi tersebut. Tujuan dari penelitian ini adalah mengevaluasi gambaran kasus kalus dan klavus berupa jenis kelamin, usia, lokasi lesi, tatalaksana, dan angka kesembuhan 1 bulan paska terapi di Unit Rawat Jalan (URJ) Kulit dan Kelamin Divisi Tumor dan Bedah Kulit (TBK) Rumah Sakit Umum Daerah (RSUD) Dr. Soetomo, Surabaya.

Metode: Penelitian deskriptif retrospektif potong lintang pada 25 Electronic Medical Records (EMR) pasien dengan kalus dan klavus yang memenuhi kriteria inklusi dan eksklusi di Unit Rawat Jalan Kulit dan Kelamin Divisi Tumor Bedah Kulit (TBK) RSUD Dr. Soetomo Surabaya periode Januari 2016 - Desember 2020.

Hasil: Dua puluh lima sampel direkrut pada penelitian ini terdiri dari 13 (52%) pasien laki-laki dan 12 (48%) pasien perempuan. Klavus mendominasi keseluruhan kasus yaitu 20 (80%) kasus, sedangkan kalus 5 (20%) kasus. Ekstremitas bawah merupakan lokasi tersering didapatkannya lesi yaitu pada 20 (80%) kasus. Eksisi merupakan metode yang paling sering dipilih yaitu pada 21 (84%) kasus. Kesembuhan klinis setelah 1 bulan paska terapi didapatkan pada 20 (80%) kasus.

Simpulan: Tatalaksana kalus dan klavus di URJ Kulit dan Kelamin Divisi TBK RSUD Dr. Soetomo, Surabaya menunjukkan angka kesembuhan sebesar 80% dengan modalitas yang paling banyak dipilih berupa eksisi.

Introduction:  Inflammation response and endothelial damage caused by COVID-19 resulting coagulopathy by increased D-dimer level. High D-dimer can predict COVID-19 severity. This research conducted to know the correlation, risk, and prediction of severe COVID-19 infection in patients with high D-dimer levels.

Method: Cross-sectional with bivariate and multivariates logistic regression analysis was conducted. Samples are ≥18 years old with COVID-19 hospitalized in Tabanan regional hospital during October 2021- March 2022. Data collected from medical records. Patients with chronic liver disease, congestive heart disease, malignancy, post-surgery, pregnancy, and deep vein thrombosis are excluded. COVID-19 severity criterias are based on COVID-19 management protocol.

Result: Of 84 patients, 63.1% males and 58.3% ≥ 60 years old. Mean D-dimer level in severe COVID-19 patients are 3,256.06 ng/ml, and 1,543.02 ng/ml in non-severe (p = 0.014, CI 95%: 435.568–2,990.51). Cut-off point of D-dimer level is 788.5 ng/ml, with 71.9% sensitivity and 69.2% specificity on the receiver operating characteristics curve. A significant correlation is found between D-dimer level above cut-off and COVID-19 infection severity (OR 5.75, CI 95%: 2.18-15.16, p= 0.001). Correlation is still significant after variables age ≥60 years old and DM comorbidity adjusted (OR 5.32, CI 95%: 1,922-14,729, p=0.001). Probability of severe COVID-19 infection in patients ≥60 years old with D-dimer level > 788.5 ng/ml and has DM comorbidity is 83.24%.

Conclusion: COVID-19 infection severity correlates with increased D-dimer levels with risk more than 5 times after variables age ≥60 years old and DM comorbidity adjusted, with moderate categorized prediction accuracy.

Pendahuluan: Respon inflamasi dan kerusakan endotel akibat COVID-19 menyebabkan terjadinya koagulopati, ditandai dengan peningkatan kadar D-dimer. D-dimer tinggi diperkirakan dapat memprediksi keparahan COVID-19. Penelitian ini dilakukan untuk mengetahui hubungan, besar risiko, dan prediksi terjadinya infeksi COVID-19 berat pada penderita D-dimer tinggi.

Metode Penelitian:  Penelitian ini merupakan penelitian cross-sectional dengan analisis bivariat chi-square dan regresi logistik multivariat. Sampel adalah penderita ≥18 tahun dengan COVID-19 yang dirawat di RSUD Tabanan periode Oktober 2021-Maret 2022. Data diambil dari rekam medik. Penderita penyakit hati kronik, penyakit jantung kongestif, keganasan, paska pembedahan, hamil, dan deep vein thrombosis dieksklusi. Kriteria keparahan COVID-19 menggunakan buku pedoman protokol tatalaksana COVID-19.

Hasil Penelitian: Dari 84 penderita memenuhi kriteria, 63,1% laki-laki, 58,3% umur ≥ 60 tahun. Rata-rata kadar D-dimer pada infeksi COVID-19 berat 3.256,06 ng/ml dan 1.543,02 ng/ml pada infeksi COVID-19 tidak berat (p = 0,014, IK 95 %: 435,568 – 2.990,51).  Nilai cut off kadar D-dimer didapatkan 788,5 ng/ml dengan sensitivitas 71,9%, spesifisitas 69,2% pada receiver operating characteristics curve. Didapatkan hubungan bermakna D-dimer diatas cut off dengan tingkat keparahan infeksi COVID-19 (OR 5,75, IK 95%: 2,18-15,16, p= 0,001) Hubungan ini tetap bermakna setelah diperhitungkan faktor usia ≥60 tahun dan komorbid DM (OR 5,32, IK 95%: 1.922-14.729, p = 0,001). Probabilitas terjadinya infeksi COVID-19 berat pada penderita usia ≥60 tahun dengan D-dimer > 788,5 ng/ml dan komorbid DM adalah 83,24%.

Simpulan: Keparahan infeksi COVID-19 berhubungan dengan peningkatan kadar D-dimer dengan risiko lebih dari lima kali setelah diperhitungkan faktor usia dan komorbid DM dengan akurasi prediksi kategori sedang.

Background: Diabetes mellitus causes many complications, both microvascular and macrovascular, especially cognitive function. Related studies are being carried out to determine the relationship between diabetes and cognitive decline as assessed through GLUT4 expression in the hippocampus. The aimed of this study was to determine the effect of fasting blood sugar on hippocampal neuronal GLUT4 expression in STZ and NA-induced diabetic rats.

Methods: This study was an experimental design, using 24 males Rattus novergicus which were divided into a control group terminated on day 14 (A0) and 28 (B0) and a diabetes group terminated on day 14 (A1) and 28 (B2). Diabetes was induced using intraperitoneal injection of streptozotocin (STZ) and Nicotinamide (NA). Spatial memory (travel time) of rats was assessed on days 14 and 28. Sampling used secondary data, fasting blood glucose (FBG) was measured using a glucometer and brain tissue was taken to assess GLUT4 expression using immunohistochemical methods. Differences in the mean FBG and GLUT4 expression between groups on days 14 and 28 and were tested statistically using SPSS version 22

Results: The mean FBG and GLUT4 expression in the diabetic group were significantly higher than those in the control group on day 14 and day 28. However, it was not significant compared between diabetes groups on day 14 and day 28. Immunohistochemical examination confirmed these results. There is a strong correlation between mean FBG levels and mean GLUT4 expression with travel time in the diabetes group on days 14 and 28 (r=0.88, p<0.05).

Conclusion: Fasting blood glucose levels significantly affected hippocampal neuronal GLUT4 expression in STZ and NA-induced diabetic rats.

Latar belakang: Diabetes mellitus banyak menimbulkan komplikasi serius baik mikrovaskuler dan makrovaskuler, khususnya pada fungsi kognitif. Studi terkait sedang terus dilaksanakan untuk mengetahui hubungan terkait antara kondisi diabetes dengan penurunan fungsi kognitif yang dinilai memalui ekspresi GLUT4 di hippocampus. Tujuan dari penelitian ini adalah untuk mengevaluasi pengaruh kadar gula darah puasa terhadap ekspresi GLUT4 neuron hipokampus pada tikus model diabetes.

Metode: Penelitian dengan desain eksperimental, menggunakan 24 ekor Rattus novergicus jantan yang dibagi menjadi kelompok kontrol yang diterminasi pada hari ke-14 (A0) dan 28 (B0) dan kelompok diabetes yang diterminasi pada hari ke-14 (A1) dan 28 (B2). Diabetes diinduksi menggunakan suntikan streptozotocin (STZ) dan Nikotinamid (NA) secara intraperitoneal. Memori spasial (waktu tempuh) tikus dinilai pada hari ke-14 dan 28. Pengambilan sampel menggunakan data sekunder, gula darah puasa (GDP) diukur menggunakan glucometer dan pengambilan jaringan otak dilakukan untuk penilaian ekspresi GLUT4 menggunakan metode imunohistokimia. Perbedaan rerata GDP dan ekspresi GLUT4 antar kelompok pada hari ke-14 dan 28 serta dilakukan uji secara statistik menggunakan SPSS versi 22.

Hasil: Rerata GDP dan ekspresi GLUT4 pada kelompok diabetes secara signifikan lebih tinggi dibandingkan dengan kontrol pada hari ke-14 maupun hari ke 28. Akan tetapi tidak signifikan dibandingkan antar kelompok diabetes pada hari ke-14 dengan hari ke-28. Pemeriksaan imunohistokimia mengkonfirmasi hasil ini. Terdapat korelasi yang kuat pada hubungan yang rerata kadar GDP dengan rerata ekspresi GLUT4 dengan waktu tempuh pada kelompok diabetes pada hari ke-14 dan 28 (r=0,88, p<0,05).

Simpulan: Kadar gula darah puasa berpengaruh secara signifikan terhadap ekspresi GLUT4 neuron hipokampus pada tikus model.

Background: Syphilis is one of the most common sexually transmitted infections every year. In mothers who do not receive treatment, transmission of infection from mother to fetus can occur, causing congenital syphilis. The purpose of this study was to describe the characteristics of cases of congenital syphilis in Wangaya Hospital, Denpasar.

Methods: This descriptive study used the medical records of pediatric patients at the Wangaya Hospital, Denpasar, for the period January 2020 to October 2021. The inclusion criteria used were newborns diagnosed with congenital syphilis with complete medical record data. The exclusion criteria used were newborns suffering from congenital syphilis accompanied by other infections, namely Toxoplasma gondii, rubella, cytomegalovirus, herpes simplex, and other congenital disorders not related to syphilis.

Results: Of the 47 study subjects who met the inclusion criteria, 68.1% of cases were asymptomatic and 31.9% symptomatic, 68.1% of term pregnancy, 31.9% preterm, low birth weight 29.8%, very low 4 .3%, and 66% normal body weight. Clinical manifestations found in symptomatic cases were respiratory distress (27.7%), jaundice/jaundice (21.3%), anemia (19.1%), skin lesions/rash (12.8%), sepsis (10 .6%), leukocytosis (10.6%), and thrombocytopenia (10.6%). Outcome of survival was 93.6% and death was 6.4% of cases.

Conclusion: Most cases of congenital syphilis are asymptomatic. In symptomatic cases, the characteristic clinical manifestations that are often encountered are respiratory distress, jaundice, anemia, skin rash, sepsis, leukocytosis, and thrombocytopenia. Recognizing the characteristics of congenital syphilis cases early is very important to reduce mortality from the disease.

Latar Belakang: Sifilis merupakan salah satu infeksi menular seksual yang banyak terjadi setiap tahunnya. Pada ibu yang tidak mendapatkan pengobatan, dapat terjadi transmisi infeksi ibu ke janin sehingga menyebabkan kejadian sifilis kongenital. Tujuan penelitian ini adalah untuk mengetahui gambaran karakteristik dari kasus-kasus sifilis kongenital di RSUD Wangaya kota Denpasar.

Metode: Penelitian deskriptif ini menggunakan rekam medis pasien anak di RSUD Wangaya kota Denpasar periode Januari 2020 hingga Oktober 2021. Kriteria inklusi yang digunakan adalah bayi baru lahir yang didiagnosis sifilis kongenital dengan data rekam medis yang lengkap. Kriteria eksklusi yang digunakan adalah bayi baru lahir yang menderita sifilis kongenital disertai infeksi lainnya, yaitu Toxoplasma gondii, rubella, cytomegalovirus, herpes simplex, maupun kelainan kongenital lain yang tidak berkaitan dengan sifilis.

Hasil : Dari 47 subjek penelitian yang masuk di dalam kriteria inklusi, 68,1% kasus asimptomatik dan 31,9% simptomatik, kehamilan aterm 68,1%, kurang bulan 31,9%, berat badan lahir rendah 29,8%, sangat rendah 4,3%, dan berat badan normal 66%. Manifestasi klinis yang ditemukan pada kasus simptomatik, yaitu distres nafas (27,7%), ikterus/jaundice (21,3%), anemia (19,1%), lesi/ruam kulit (12,8%), sepsis (10,6%), leukositosis (10,6%), dan trombositopenia (10,6%). Luaran hidup 93,6% dan meninggal 6,4% kasus.

Kesimpulan : Sebagian besar kasus sifilis kongenital tidak bergejala atau asimptomatik. Pada kasus bergejala, karakteristik manifestasi klinis yang sering ditemui adalah distres nafas, jaundice, anemia, ruam kulit, sepsis, leukositosis, dan trombositopenia. Mengenali karakteristik kasus sifilis kongenital sejak dini sangat penting untuk mengurangi mortalitas dari penyakit.

Background: Ovarian cancer is one of the most common malignant tumors found in reproductive organs in vitro. Secretory Leukocyte Protease Inhibitor (SLPI) protein is essential for the growth of ovarian cancer cells, a protein that maintains the survival of ovarian cancer cells, inhibits antiproliferative effects, and reverses the proapoptotic effect of elastase. This study aims to evaluate the role of SLPI in diagnosing ovarium cancer.

Methods: The research was conducted at the Obstetrics and Gynecology Polyclinic, Sanglah Hospital, Denpasar and the Prodia Laboratory. Sampling of this study has been carried out by previous researchers in research on the accuracy of serum levels of insulin-like growth factor binding protein 2 in diagnosing ovarian cancer. The research sample (intended sample) was women aged 18 years and over with ovarian tumors who came to the Obstetrics and Gynecology Polyclinic, Sanglah Hospital, Denpasar. Data were analyzed using SPSS versi 22 for Windows.

Results: The proportion of epithelial types was significantly higher in the ovarian cancer group. In ovarian cancer samples, the most samples were obtained at FIGO III Stage. Median CA125 levels, RMI scores, and SLPI levels were significantly higher in the group with ovarian cancer. The cut off value of serum SLPI used in this study was 54,000 pg/ml which was obtained from preliminary analysis on 26 training samples. Sensitivity: 78.3; specificity:66.7%; Positive predictive value: 78.3%; Negative predictive value: 66.7% Accuracy: 73.6%.

Conclusion: In a diagnostic test study to assess the accuracy of SLPI serum in supporting the diagnosis of ovarian cancer, it was found that SLPI serum had good sensitivity, specificity, PPV, NPV, and accuracy values.

Latar Belakang: Kanker ovarium merupakan salah satu tumor ganas yang paling sering ditemukan pada organ reproduksi secara in vitro. Protein Secretory Leukocyte Protease Inhibitor (SLPI) sangat esensial untuk pertumbuhan sel kanker ovarium, protein yang menjaga kelangsungan hidup sel kanker ovarium, inhibisi efek antiproliferatif, dan membalikkan efek proapoptosis dari elastase. Penelitian ini bertujuan untuk mengevaluasi peran SLPI dalam mendiagnosis kanker ovarium.

Metode: Penelitian dilakukan di Poliklinik Kebidanan dan Penyakit Kandungan RSUP Sanglah Denpasar dan Laboratorium Prodia. Pengambilan sampel penelitian ini sudah dilakukan oleh peneliti sebelumnya pada penelitian tentang akurasi kadar serum insulin-like growth factor binding protein 2 dalam mendiagnosis kanker ovarium. Sampel penelitian (intended sample) adalah wanita berusia 18 tahun ke atas dengan tumor ovarium yang datang ke Poliklinik Kebidanan dan Penyakit Kandungan RSUP Sanglah Denpasar.

Hasil: Proporsi tipe epitelial secara signifikan lebih banyak pada kelompok kanker ovarium. Pada sampel kanker ovarium, didapatkan sampel paling banyak pada Stadium FIGO III. Median kadar CA125, skor RMI, dan kadar SLPI secara signifikan lebih tinggi pada kelompok dengan kanker ovarium. Nilai cut off serum SLPI yang digunakan pada penelitian ini adalah 54.000 pg/ml yang didapatkan dari analisa pendahuluan pada 26 training sample Sensitivitas:78,3; spesifisitas:66,7%; Nilai prediksi positif: 78,3%; Nilai prediksi negatif: 66,7% Akurasi: 73,6%.

Kesimpulan: Pada penelitian uji diagnostik untuk menilai akurasi serum SLPI dalam menunjang diagnosis kanker ovarium didapatkan bahwa serum SLPI memiliki nilai sensitivitas, spesifisitas, PPV, NPV, dan akurasi yang baik.